Non-viable baby, born alive -parent won't hold him, what do you do?

DutchgirlRN, ASN, RN · Sep 20, 2005

Dutchgirl: you don't need to feel guilty. @ 22wks, the baby was not viable. You did a great job. Sometimes, a baby is born @ that gestation and even cries. But lung buds are just starting to develop into airsacs--not really enough to ventilate. Vanderbilt couldn't have saved the baby either. You did fine.

Thank you and hugs prmenrs. You've made me feel alot better ! It's been a while since I've thought of that little boy but each time I do I feel so bad.

jeepgirl, LPN, NP · Sep 20, 2005

If the baby was alive without intervention for 3 hours... gosh, do you think it would have done well in the NICU? I mean, I know that they have done 22 weekers before.

OK, so here's what happened - and it's not the first time we've had this dilemma. We had a pt come in with severe, unmedicated schizophrenia, homeless, and imminently going to deliver a 21-22wk baby. Well, she delivered the baby and he was alive. He lived for 3hrs. The pt only held the baby for a few moments and wanted us to take him away. To make a long story short, another coworker and I took turns so he wouldn't be alone for those 3 long hours.
What does your facility do in that situation - when a baby is not viable, but born alive, and the parent(s) don't want to hold the baby? I mean, this was a perfect little 1 lb baby, pink with a heartbeat. We couldn't just leave him on the counter in our back room and occassionally check for a heartbeat so time of death could be recorded. (!) At least, I couldn't. Anyway, just wondering how other units handle this. thanks, SG

Jolie, BSN · Sep 20, 2005

If the baby was alive without intervention for 3 hours... gosh, do you think it would have done well in the NICU? I mean, I know that they have done 22 weekers before.

In all likelihood, no. As prmenrs stated, a 22 weeker simply doesn't have sufficient lung development to survive long term, even with mechanical ventilation. Those are the babies that look just good enough at birth to be taken to the NICU, only to crump within hours because they've out-stripped the ability of their tiny lungs to support life.

The only suggestion I can possibly add is to offer baptism to the parents. In this case, it sounds as if the mother would not have been in a frame of mind to make such a decision, but to parents who are experiencing an unexpected loss, knowing that their baby has been baptized may be of comfort.

Editorial Team / Admin · Sep 20, 2005

In all likelihood, no. As prmenrs stated, a 22 weeker simply doesn't have sufficient lung development to survive long term, even with mechanical ventilation. Those are the babies that look just good enough at birth to be taken to the NICU, only to crump within hours because they've out-stripped the ability of their tiny lungs to support life.
The only suggestion I can possibly add is to offer baptism to the parents. In this case, it sounds as if the mother would not have been in a frame of mind to make such a decision, but to parents who are experiencing an unexpected loss, knowing that their baby has been baptized may be of comfort.

Excellent point, Jolie,

I can remember many years ago. This new born baby was dying. No clergy at all in the hospital and mom was beside herself.

I remembered my nursing class and the issue of baptism.

I took that babe in my arms, said the Lords' Prayer, made the sign of the cross on his forehead, using water from the tap which I placed in a small basin. He died as I was handing him back to his mom.

I will NEVER EVER forget the look on her face. It was the look of sheer peace.

babynurselsa, RN · Sep 20, 2005

You did it exactly right. Hold the little one close and keep him warm and comfortable as possible. You can always ask if there is any other family present who would want to sit with and hold the infant in another room. In this case it doesn't sound like you had that. I saw one similar little one who hung on for about 6 hours. The human spirit, no matter how small the package, is an amazing thing.

NorthernRose · Sep 20, 2005

To all of yous that have held a premie.....Bless You!! From a mom of a Lil'one Thank you!!! Mine was born at 1lb, 14 oz 22 years ago....I Bless the ladies that had taken care of her every day!! My lil 1 lb 14 oz now has little ones of her own, but to those of you whohold those in your arms who dont make it...Thank you. You have a place in all our mom's hearts. THANK YOU!!!! You might never know thatyou holding our babies makes a difference to us but it really does! THANK YOU!!!

HONEYBEAR · Sep 20, 2005

To all you OB nurses out there.....THANK YOU.....I feel that it takes a special kinda nurse to take care of the premature or non viable babies......Thank You.

shannymar · Sep 20, 2005

wow. thank all of you for being angels on earth. you truly are what makes this world great. i don't have the courage that which you do. thank you. :kiss

Shannon

-Loving wife to Zechariah

-Mommy to Kayla Maylin born April 3, 2005 7 lbs. 3 oz. Had two strokes at birth due to the a high homocysteine level caused by the MTHFR genetic mutation. And she is absolutely PERFECT!!! Kids have strokes too! All life is fragile...

-and future CNA and Nurse!

eltrip · Sep 20, 2005

Originally Posted by enfermeraSG
OK, so here's what happened - and it's not the first time we've had this dilemma. We had a pt come in with severe, unmedicated schizophrenia, homeless, and imminently going to deliver a 21-22wk baby. Well, she delivered the baby and he was alive. He lived for 3hrs. The pt only held the baby for a few moments and wanted us to take him away. To make a long story short, another coworker and I took turns so he wouldn't be alone for those 3 long hours.

You did exactly the right thing. Thank you for being there for that precious little soul!

Schmoo1022 · Sep 20, 2005

I do not know how you guys do it...bless your hearts.

Jeannette

Gompers, BSN, RN · Sep 20, 2005

We do the same thing, basically. If it's a baby determined to be non-viable, or if the parents choose to take the baby off the vent (for things like asphyxia, congenital anomolies, severe IVH, extreme prematurity, etc.) and the parents aren't able to be there to hold the baby the whole time...then we take turns doing it. We try to make the baby as comfortable as possible, dress the baby, and hold him/her in a warm blanket while we sit in a rocking chair or carry the baby around. Lots of soft humming, singing, storytelling, lullaby music, that kind of thing.

Of course, it's one of the hardest things we ever have to do in our jobs, but it's also one of the most beautiful and compassionate gestures we ever provide. We treat these babies with respect and try to make their few hours on earth special. I think some of the moments I cherish most in my nursing career have been associated with caring for a dying infant like this.

Long Term Care Columnist / Guide · Sep 20, 2005

Please, let's look at this from a parent's point of view and not be quite so judgmental about "not wanting" the baby.

I was a 25-year-old emotional train wreck when my full-term, 6-pound 9-oz. anencephalic daughter was delivered by C-section, many years ago. I couldn't handle the idea of seeing her, much less holding her, at that time, and while I wish to Heaven I'd been strong enough, I simply wasn't. My husband did see and hold her during her 7 hours on earth; he was also with the priest when she was baptized, and with me when my doctor came in to tell me she was gone.

I thank God he was able to deal, because I couldn't, and the guilt I felt then still is with me in some ways. But as much as I wish I could've done things differently, I've come to the realization that I did only what I could at the time.........if anyone had forced me to hold my dying child, I think I'd have literally gone crazy. I was young, emotionally immature, and I was so close to hysteria that I spent an entire night with the blankets over my head, screaming silently, wishing I were dead alongside my daughter.........the only thing that kept me from crying out loud was the desire not to end up in the psych ward. :crying2:

So that's why I ask that you put yourselves in the place of a young mother for a moment and try to understand why one might not want to see or touch the baby. Yes, she may wind up regretting it---God knows I do---but everyone deals with things in their own way, and our job as nurses is to support them regardless of how we feel about their decision.

In the meantime, you're right about not letting babies die alone.......I thank the Lord that there was a nurse to hold my child as she took her last breath, and I bless that woman every day for being there for her.